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California state mental hospitals plagued by peril

A costly federal effort to reduce heavy drugging and improper restraining fails to improve care and help patients control violent impulses. Instead, assaults by patients soar and confinements grow longer.

April 15, 2012|By Lee Romney and John Hoeffel, Los Angeles Times

When Garth Webb was sent to Napa State Hospital, his parents were relieved.

The bellboy and amateur composer from Sebastopol had been in the throes of bipolar disorder when he was charged with threatening the lives of co-workers. His family encouraged him to plead not guilty by reason of insanity, thinking that in a mental hospital he would get the treatment he needed.

Instead, Webb and his parents say, he was repeatedly brutalized. His main tormentor, a patient in the room next door, assaulted him several times, wrapping him in a headlock and sexually abusing him.

Soon after, the same man strangled a psychiatric worker on the hospital grounds.

"Since I've been here, that's what I've witnessed ... these random acts of violence," Webb, now 31, said in an interview from the hospital. "It was a rude awakening."

Webb's ordeal offers a window on the failings of a six-year effort to improve conditions in California's public mental hospitals at a cost of hundreds of millions of dollars.

In 2006, theU.S. Department of Justicesued the state, alleging that it was violating patients' rights by heavily drugging and improperly restraining them and failing to provide appropriate treatment. The state settled, agreeing to an extensive court-supervised improvement plan at four hospitals with more than 4,000 patients.

But a Times investigation found that the plan has failed to achieve the Justice Department's main objective: to raise the level of care so patients could control their violent tendencies and would not be institutionalized any longer than necessary.

Under the plan, the use of restraints and certain medications declined. But by the end of last year, the rate of patient assaults on other patients and staff members had doubled at Metropolitan State Hospital in Norwalk and Atascadero State Hospital in San Luis Obispo County, according to an analysis of state data.

The assault rate at Napa more than tripled over two years, dropping only after the killing of the psychiatric worker triggered a lockdown.

Only at Patton State Hospital in San Bernardino did assaults decrease — by 15%.

Patients, most of whom have committed crimes linked to their illnesses, are also being confined longer, records show. Those judged not guilty by reason of insanity, for instance, were held nine months longer on average in 2011 than in 2006.

Despite the rising violence and longer periods of confinement, the Justice Department expressed overall satisfaction with the pace of improvements in the hospitals, and in November it allowed its oversight of Patton and Atascadero to expire.

But in December, the department unexpectedly asked a federal court to extend oversight of both Metropolitan and Napa, asserting in court papers that their patients remained "at serious risk of harm, even death."

In support of that request, a federal court monitor charged with evaluating the state's progress cited 12 cases at the two hospitals in which patients died or were seriously injured because of lapses in care. A ruling is expected in June.

Meanwhile, the state Department of Mental Health — under new leadership — has begun dismantling many of the changes instituted at the hospitals.

"It was a huge, very expensive, very idiotic experiment that failed badly," Dr. Mubashir Farooqi, a psychiatrist at Patton, said of the reform effort.

Under pressure from higher-ups to place the fewest possible restrictions on patients, hospital staff members grew reluctant to take assertive action against violent or unruly ones, according to state records and interviews with hospital officials, employees, patients and their families.

Paperwork intended to document progress toward about 360 separate objectives left staff members with far less time for patients and less flexibility to craft suitable treatments.

"They have succeeded in putting in all these measures and employing people to count their forms," said Mel Hunter, former executive director of Atascadero, who left the hospital in 2007 because of his objections to the changes. "But in terms of reduction in cost, reduction in time served in treatment and reduction in violence, it's a failure."

Chief reformer

The architect of the reforms was Nirbhay Singh, a Virginia-based consultant.

Singh came to the United States in 1987 from New Zealand, where he had served as psychology director at an institution for the mentally retarded. He became a professor of psychiatry at Virginia Commonwealth University and developed specialties in "person-centered" care — designed to build on a patient's strengths — and "positive behavior support."

Singh had scant experience treating psychiatric patients, let alone the sort of dangerous offenders who fill the state hospitals. He specialized in research on the developmentally disabled, particularly children, and published articles about Buddhist-inspired mindfulness and alternative treatments, such as using the herb kava as a calming agent.

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